| NPI | 1841611761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN212023) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: GA RN212023) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2014-11-10 |